A5029532621- Trauma, Hemostasis, Coagulopathy, Resuscitation
- Trauma and Emergency Care Studies
- Abdominal Trauma and Injuries
- Blood transfusion and management
- Mechanical Circulatory Support Devices
- Cardiac Arrest and Resuscitation
- Blood donation and transfusion practices
- Cardiac Structural Anomalies and Repair
- Respiratory Support and Mechanisms
- Traumatic Brain Injury and Neurovascular Disturbances
- Sepsis Diagnosis and Treatment
- Intensive Care Unit Cognitive Disorders
- Hemodynamic Monitoring and Therapy
- Cardiac Valve Diseases and Treatments
- Cardiac, Anesthesia and Surgical Outcomes
- Family and Patient Care in Intensive Care Units
- Acute Kidney Injury Research
- Emergency and Acute Care Studies
- Renal function and acid-base balance
- Infective Endocarditis Diagnosis and Management
- Hemostasis and retained surgical items
- HIV-related health complications and treatments
- Intracranial Aneurysms: Treatment and Complications
- Pneumocystis jirovecii pneumonia detection and treatment
- Intracerebral and Subarachnoid Hemorrhage Research
Gold Coast Hospital
2015-2025
The University of Queensland
2016-2025
Monash University
2017-2025
St Andrew’s Hospital
2019-2024
Griffith University
2016-2024
Gold Coast Health
2019-2023
Queensland Health
2023
Singapore General Hospital
2022
Memorial Hospital
2021
Australian Regenerative Medicine Institute
2020
Importance Whether β-lactam antibiotics administered by continuous compared with intermittent infusion reduces the risk of death in patients sepsis is uncertain. Objective To evaluate whether vs a antibiotic (piperacillin-tazobactam or meropenem) results decreased all-cause mortality at 90 days critically ill sepsis. Design, Setting, and Participants An international, open-label, randomized clinical trial conducted 104 intensive care units (ICUs) Australia, Belgium, France, Malaysia, New...
Haemorrhage is a leading cause of death in severe trauma. Fibrinogen plays critical role maintaining haemostasis traumatic haemorrhage. Early fibrinogen replacement recommended by several international trauma guidelines using either concentrate (FC) or cryoprecipitate (Cryo). There limited evidence to support one product over the other with widespread geographic and institutional variation practice. This pilot trial first randomised controlled comparing FC Cryo The In Severe Trauma studY...
Abstract Introduction The management of patients with critical bleeding requires a multidisciplinary approach to achieve haemostasis, optimise physiology, and guide blood component use. 2011 Patient guidelines: module 1 — bleeding/massive transfusion were updated published. Systematic reviews conducted for pre‐specified research questions, recommendations based on meta‐analyses included studies. Main guideline includes seven 11 good practice statements addressing: major haemorrhage protocols...
Patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) frequently develop arterial hyperoxaemia, which may be harmful. However, lower oxygen saturation targets also lead to harmful episodes of hypoxaemia. In this registry-embedded, multicentre trial, we randomly assigned adult patients VA-ECMO in an intensive care unit (ICU) either a conservative (target SaO2 92–96%) or liberal strategy 97–100%) through controlled administration via the ventilator and ECMO gas blender....
IMPORTANCE: Blood transfusions are a common and potentially lifesaving intervention in ICU patients but associated with harm often transfused inconsistently guidelines. However, it is not well known how transfusion practice has recently changed if there variation practice. OBJECTIVES: To describe blood practices ICU, the across sites, to compare against national guidelines prior published DESIGN, SETTING, AND PARTICIPANTS: A prospective, multicenter, binational, observational study conducted...
Guidelines recommend an initial intravenous (IV) fluid bolus of 30 ml/kg isotonic crystalloid for patients with sepsis and hypotension. However, there is a lack evidence from clinical trials to support this. Accumulating observational data suggest harm associated the injudicious use fluids in sepsis. There currently equipoise regarding liberal or restricted fluid-volume resuscitation as first-line treatment sepsis-related A randomised trial comparing these two approaches is, therefore,...
Background: Haemorrhage is a major cause of death in severe trauma. Fibrinogen plays critical role maintaining haemostasis traumatic haemorrhage, and early replacement using fibrinogen concentrate (FC) or cryoprecipitate (Cryo) recommended by several international trauma guidelines. Limited evidence supports one product over the other, with widespread geographic institutional variation practice. Two previous trials have investigated feasibility rapid FC administration severely injured...
Trauma care represents a complex patient journey, requiring multidisciplinary coordinated care. Team members are human, and as such, how they feel about their colleagues work affects performance. The challenge for health service leaders is enabling culture that supports high levels of collaboration, co-operation coordination across diverse groups. We aimed to define improve relational aspects trauma at Gold Coast University Hospital.We conducted mixed-methods collaborative ethnography using...
Fibrinogen is the first coagulation protein to reach critical levels during traumatic haemorrhage. This laboratory study compares paired plasma samples pre- and post-fibrinogen replacement from Early In Severe Trauma studY (FEISTY; NCT02745041). FEISTY randomised controlled trial compare time administration of cryoprecipitate (cryo) fibrinogen concentrate (Fg-C; Riastap) in trauma patients. will determine differences clot strength fibrinolytic stability within individuals between treatment arms.
Abstract Objective To describe the relationships between different methods of measuring functional fibrinogen levels in severely injured, bleeding trauma patients across multiple timepoints during hospitalisation. Methods In 100 adult enrolled FEISTY pilot randomised clinical trial at four tertiary centres Australia, blood samples were collected prospectively. Consistency agreement was calculated, comparing measured by – ROTEM® Delta and Sigma FIBTEM A5, TEG® 6s CFF MA, gold‐standard Clauss...
Recent advances in the technology of extracorporeal respiratory assist systems have led to a renewed interest carbon dioxide removal (ECCOR). The Hemolung is new, low-flow, venovenous, minimally invasive, partial ECCOR device that has recently been introduced clinical practice aid avoiding invasive ventilation or facilitate lung-protective ventilation.We report our early experience on use, efficacy and safety three Australian intensive care units.Retrospective review all patients with acute...
Sepsis is associated with abnormal host immune function in response to pathogen exposure, including endotoxin (lipopolysaccharide; LPS). Cytokines play crucial roles the induction and resolution of inflammation sepsis. Therefore, primary aim this study was investigate effects endogenous tetrapyrroles, biliverdin (BV) unconjugated bilirubin (UCB) on LPS-induced cytokines human blood. Biliverdin UCB are by products haem catabolism have strong cytoprotective, antioxidant anti-inflammatory...
Objective: Fibrinogen is one of the first coagulation factors to be depleted during traumatic haemorrhage, and evidence suggests hypofibrinogenaemia leads poor outcomes. A number fibrinogen replacement products are currently available, with no clear consensus on ideal product use in severe haemorrhage. We hypothesised that it will possible rapidly administer concentrate (FC) guided by rotational thromboelastometry (ROTEM) FIBTEM A5 patients presenting trauma Methods: examined 36 consecutive...
Introduction: Trauma-induced coagulopathy (TIC) is a form of unique to trauma patients and associated with increased mortality. The complexity incomplete understanding TIC have resulted in controversies regarding optimum management. This review aims summarise the pathophysiology appraise established emerging advances management TIC. Methods: narrative based on literature search (MEDLINE database) completed October 2020. Search terms used were “trauma induced coagulopathy”, “coagulopathy...
A 44-year-old man presented to hospital 24 h after an intentional overdose of metformin and gliclazide. He had a critical metabolic acidosis on presentation with pH 6.88, very rapidly deteriorated into distributive shock refractory large volume fluid resuscitation massive doses vasopressors. We introduced methylene blue infusion as rescue therapy in attempt improve the patient's haemodynamics, which was successful. The patient made full recovery no long-term sequelae.
Abstract Purpose To investigate the effect of IV fluid resuscitation on endothelial glycocalyx (EG) shedding and activation vascular endothelium inflammation. Materials methods A planned biomarker sub-study REFRESH trial in which emergency department (ED) patients) with suspected sepsis hypotension were randomised to a restricted fluid/early vasopressor regimen or later vasopressors if required (usual care). Blood samples collected at randomisation (T0) 3 h (T3), 6 (T6)- 24 (T24) for...